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Sex before marriage is a sin punishable by death. She who abstains is the deserving and accepted woman in the society…

This is the gospel at least all girls grow up not only listening to but also trying so hard to abide by.

Without a doubt, abstinence is the best message to preach to young people but we are burying our heads in the sand assuming this message is consumed and practiced wholesomely.

In Muhoroni Mixed Secondary school, the head teacher is one sad man since he cannot stand seeing his girls one by one drop out of school as a result of pregnancy and his boys suffering from STIs.

Since the abstinence gospel has not been adhered to, he has taken measures to combat the increasing teenage pregnancies. First, the girls and boys learn in different rooms despite being in a mixed school!

Secondly, the girls are subjected to periodic pregnancy tests in a bid to scare them. Unfortunately, these measures have failed since pregnancy cases are still being reported. Just who is responsible for the pregnancies?

The principal sought outside help and invited KMET to talk to his students. During a very interactive session, the girls revealed that most of their friends and classmates are being impregnated by laborers in the sugar cane plantations commonly referred to as obanda.

Obanda seems to be having easy cash to issue. Most of the other girls on the other hand are poor and are struggling to belong to a class of fashionable ladies.

“I would wish to put on beautiful expensive clothes like other ladies but I cannot afford on my own. That is why I would easily accept money from obanda,” says one of the girls.

Unfortunately for them, the goodies are not for free. The payment is sex. The saddest part is that the sexual act takes place in the sugarcane plantations. Most of the time condoms are not used and the result is another teen pregnant and has to drop out of school. Obanda then moves to the next prey.

The youth peer providers helped the girls understand the dangers of engaging in unprotected sex. Getting pregnant and dropping out of school could not be a grave consequence as death during delivery or while procuring unsafe abortion. They were also reminded they stand a high chance of HIV and STI infection.

We also enlightened the girls on their sexual reproductive health rights to enable them make informed choices and of course the use of contraceptives unto them that cannot wait for the right time to engage in sex.

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Fistula is a tear in a woman’s bladder or rectum that causes her to constantly leak urine or faeces.

Two million women suffer from the condition with 50,000 to 100,000 new cases occurring every year worldwide.

The main causes are prolonged labour, botched Caesarean section and sexual assault.

Are their types of this disease?

There are two kinds of fistula.

Obstetric fistula which is an abnormal opening in the birth canal. It’s an injury that occurs during child birth, usually when a woman is in labour for too long or when the delivery is obstructed.

Traumatic fistula which is an abnormal opening in the birth canal between the bladder and rectum resulting in incontinence. It’s an injury caused by rape or sexual violence

Does it affect women in Kenya?

More than two million women in Kenya suffer from fistula complications. This situation is further aggravated by delayed treatment because of limited facilities.

Most victims suffer pain and stigma. The cases are high in parts of North Rift, Western and Nyanza region.

Who is mostly at risk of fistula?

Most fistulas occur among women living in poverty, in cultures where a woman’s status and self-esteem may depend almost entirely on her marriage and ability to bear children, notes UNFPA.

Are they factors that increase one chances of getting affected?

The risk of obstetric fistula often begins when young girls get pregnant early, before their bodies are able to safely sustain a pregnancy. The unease surrounding sex education in Kenyan schools is one of the reasons for early pregnancy due to a lack of accurate reproductive health knowledge,

Female Genital Mutilation: Infibulation, practiced in some communities, which involves the cutting and sewing up of a girl’s genitalia leaving a match-stick size hole for the passage of menstrual blood is especially harmful. This hole is then crudely cut open during childbirth, something which could end up severing the bladder.

Myths and misconceptions surrounding fistula

Fistula is sometimes linked to taboo conditions such as HIV/AIDS, abortion and infertility. Fistula survivors may be thought to be bewitched or cursed, or may be accused of being promiscuous. There is also a refusal by some women to give birth in hospitals due to the belief that they will receive injections that will cause infertility, or be forced to have unnecessary Caesarean births.

Stigma

Women and girls with fistula are often abused, beaten, abandoned, and isolated. Without repair, fistula may cause a fetid odour, frequent pelvic and urinary infections, painful genital ulcerations, infertility and nerve damage to the legs.

Affected women may miss out on crucial information on treatment and support, due to a lack of social interaction.

Home therapies

Due to the stigma associated with leaking urine, women sometimes refuse to drink water, making the urine more concentrated and resulting in the burning of the vulva; some also develop kidney disorders. In some communities, women seek to control the seepage of urine by inserting hot rods in an attempt to “seal” the fistula, causing more damage.

Lack of reproductive health education coupled with widespread ignorance of the basic facts also contributes to misconceptions. Because even medical personnel have insufficient information this has hindered timely referrals for the patient’s.

Is there treatment for fistula?

Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy.

Typically the first step in treating a fistula is an examination by a doctor to determine the extent and “path” that the fistula takes through the tissue.

In some cases the fistula is temporarily covered, for example a fistula caused by cleft palate is often treated with a palatal obturator to delay the need for surgery to a more appropriate age.

Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess).

Various surgical procedures are commonly used, most commonly fistulotomy, placement of a Seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from re infecting the channel).

Treatment involves filling the fistula with fibrin glue; also plugging it with plugs made of porcine small intestine submucosa have also been explored in recent years, with variable success. Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.

According to the UNFPA, only 7.5 per cent of women are able to access fistula treatment.

Cherangany Nursing Home, Kitale in Trans Nzoia County which partners with KMET offers these services for free. Patients are refunded their transport once they get to the facility and the corrective surgery done.

In Siaya county, on June 22 to June 25 there will be a free gynaelocology examination at Sagam Hospital. KMET is partnering with the hospital to reach out to patients seeking corrective fistula surgery.

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A family in Kisumu’s Nyalenda estate is yet to come to terms with an incident where their two-year-old daughter has been defiled but no one brought to book since the girl is not able to talk.

It was a normal evening in the month of May 2015 when Pat* went out to play with other children within the neighborhood while her mother was taking shower.

Later on Pat’s mother, a 20 year old tailor, looked for her and found her at neighbor’s place, playing but upon reaching home, Pat said she wanted to go for a short call and this is when her mother noticed that her under garments was unusually dirty, characterized with some fluids.

She shared her fears with Pat’s dad who had already arrived from work and they both felt something unusual had happened to their daughter.

They tried to question Pat if anyone had touched her but she was too traumatized to say anything. They decided to take Pat to Kisumu County hospital where a provider examined Pat and confirmed that she was indeed defiled.

Ironically, the girl did not receive any medical attention, but was given a treatment appointment for the next day. Worse still, the case was never reported to the police.

According to the survivor’s mother, there was no need to report the incident to the police because their daughter would not talk hence cannot identify the perpetrator.

Unfortunately for Pat, she was not to receive any medical care for five days; not even the HIV prevention drugs commonly known as PEP due to the back and forth referrals she kept she was given at one of the at one of the referral hospitals in Kisumu County.

‘Every time I went, I found a different provider who would refer me to the one who served us first. Since he was not in, they kept giving me appointment for a next day that never came. I gave up,’ laments Pat’s mother.
Five days later when she could not get help at the government hospital, she went to a nearby private health facility.

After assessing the case, daughter and mother were referred to the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) where Pat was finally attended at the gender violence recover centre.

She was admitted for a week and underwent treatment for the physical injuries. She could not be started on HIV preventive drugs since the seventy-two hours period for initiating PEP had elapsed.

Although discharged, the child still goes for psychosocial support services at the JOOTRH Gender Violence Recovery Center, the only of its kind in Kisumu County.

The centre houses clinical officers, lab technologists, trauma conselors and recovery rooms dedicated to gender and sexual violence cases working from 8 a.m – 5 p.m on weekdays. The KEMRI/CDC supported centre however does not operate on weekends and at night.

Pat is not just a defilement survivor but her case also exposes the loopholes in our county health facilities that may add to the pain of sexual gender based violence survivors. Pat’s story raises some serious questions concerning the plight of sexual gender based violence survivors.

Do our health facilities have the capacity and resources to handle survivors of sexual violence? Is the public aware of what to do in case of sexual abuse?

Call us for free on 0800724500 or contact these numbers for help; Child line Kenya-116 and Health Assistance Kenya-1195.

If you wish to contact the JOOTRH Gender Violence Recover Centre Call 07141388868 or beep for medical attention.

Or contact us via email on:marketing@kmet.co.ke or info@kmet.co.keHelp us break the silence on such instances of human rights violation by sharing your story with us.

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Choosing the wrong condom size is common among teenagers and young adults. The wrong size can be so constricting cutting off the blood flow and as a consequence becomes rather restrictive during intercourse. This occurrence has also largely made the youth stay away from condoms. However, this needs one to be a bit more informed since condoms in the market come in three categories, the small condoms, regular size condoms and large condoms. Click here
to read more of this guest article on our website.

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Every day, about 800 women die worldwide from preventable pregnancy or child related complications with most of these deaths occurring in low resource settings.

Poverty set aside, what else could be causing high maternal mortality rates in such settings?

Amongst the Fort Ternan community in Muhoroni Sub County, it is alleged that a number of expecting women would seek delivery services from old unskilled midwives and only go to the facility in case of complications.

Surprisingly enough, the midwives offer their services at a fee yet quality services at the nearby dispensary are free of charge. What could be the reason?

‘I conceived four months after my last delivery. I was ashamed to go to the facility because it was too soon so I opted to seek the services of a midwife. I developed complications and I can’t tell what could have happened if I never went to the hospital. I swear I will never seek the services of a midwife again’, revealed Beth Onyango, a woman in her late 30s.

According to Jane (name altered) who is a young mother of two, she chose the services of an old unskilled midwife during her first delivery out of fear after she heard that nurses beat up mothers in the hospital.

Her experience was not any better since the midwife too beat her when she could not follow instructions due to the labor pains.

The community members who were speaking during a community conversation forum introduced by KMET also disclosed that those expecting twins more often lose one of their babies in the hands of these midwives.

The men who had turned up in large numbers for this forum were shocked when they heard these revelations.

Despite their involvement in taking the women to the hospital during complications, they were not aware of the risks the women faced by first seeking services from the unskilled old midwives.

When all was said, the community members decided to start sensitization sessions that would emphasize on the importance of expecting women seeking all the services from the health facility.

The men even agreed to influence the others and prohibit their wives from seeing unskilled midwives for whatever reason.

KMET has been introducing community conversation forums so that communities and especially men take maternal health issues as their responsibility.

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Mary (not her real name), a 10 year old girl, left home at around 6pm on a Friday evening to escort her friend never to be seen again. Her parents got worried and started looking for her all over in Nyamasaria town Kisumu in vain. We managed to interview the father who broke down and could not continue with the interview session but according to Mary’s mother, the girl knocked at a lady’s door at around 3am. The old lady knew her parents and supported Mary back home at around 5am. She had been assaulted and defiled. She had knife-stab marks around her neck, a scar on the back of her head, marks on her lips and her face was swollen. In the process the old woman told them that the child was defiled and unable to walk. The father went on to report the case at Nyamasaria police station while the mother rushed her to the hospital. The doctor that saw her at the onset refused to carry on with the case. But another doctor took over and Mary’s mother gave an account of the events of that morning. The mother disclosed Mary’s report of how a boda boda motorist had offered her a lift after which she could not recall where the man took her and rapped her. The mother said Mary’s account of the story was not very clear since she was hysterical and didn’t want anyone near her. We were not able to interview Mary since she was too traumatized and still in shock. The Doctor confirmed that the girl was defiled and they had put her on Post exposure prophylaxis (PEP) to take care of the risk of HIV infection. The Doctor also found traces of grass and soil inserted in the girl’s privates. Due to the girl’s swollen head and face; a CT scan or an MRI was to be done but unfortunately the parents could not afford the cost of the tests. KMET got in touch with the Kisumu County Gender Technical Working Group who came onboard to offer assistance. Due to these interventions, with the help of FIDA and PLAN international there was a resolution to airlift Mary to Nairobi women’s hospital for specialized treatment. KMET offered to Fuel the ambulance and psychosocial support to both the parents who were evidently traumatized and the girl when she gets back. The man who damaged Mary’s happy childhood life is still at large, how many more young kids will fall his prey?

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Sixteen year old Truphena discovers she is pregnant two months after schools re-open from the April holidays. For the second time she has missed to see red.
The form two student lives with her aunt and uncle in Luanda, a small town in Western Kenya. Her boyfriend with whom she has gone intimate in a few occasions is a form one student at a boy’s boarding school in Siaya County.
Truphena a total orphan is disinclined to keeping the pregnancy because she does not want to disappoint her family. She fears that her uncle who has struggled to support her and her two siblings throughout her childhood may stop paying school fees or might even send her away from home.
She can’t imagine living through the ridicule she anticipates from her peers and the unkind words from teachers in school. She confides in a friend from her class who offers to help her out.
Truphena is referred to an old lady- a herbalist, a short distance out of town. She is given about a litre of what she describes as hot mixture of herbs to take. “You will experience some bleeding for one to two days then you will become a girl again,” the old lady tells her.
Three days later Truphena is still bleeding and begins to experience backaches and abdominal pains. She gets terrified recalling a few stories she had heard from the village of girls dying from such encounters. Her friend offers no help and she is left with no option but to talk to her aunt.
I had the opportunity to meet Truphena a week later when she came to a health centre in Kisumu where I work as a communication and marketing officer. She came to thank the nurse who attended to her for saving her life and for a counselling session on contraceptive options for the youth.
According to Celestine Gambo, the Nurse in charge of the KMET Youth friendly Clinic, had Truphena’s family delayed, she would have developed septicaemia; a condition that results from the body cells being infected as a result of decomposing products of conception in the womb. She would have lost her womb or worse her life.
Truphena is not an isolated case, she forms part of the over 300,000 unsafe abortion that Kenya records in a year yet the emotive abortion debate goes on and on with little or no tangible interventions being adopted by the ministry of health.

The kind of discourse we engage in with regards to abortion deals with the rights and wrongs within moral corridors and the confines of the laws of the land. Questions like: is abortion morally wrong? What does the Kenyan law rule on abortion? How does a health provider determine a woman’s life is in danger because of the pregnancy, and how do we decide whose rights should prevail? Shall never be concluded.
However the government and partners in the private sector can make sure that every Kenyan woman does not find herself in a predicament that elicits such questions by jointly implementing the national guideline for provision of adolescent, youth-friendly services drafted in 2005, to bolster sexual reproductive information which has been kept under the rags for long.